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A widening racial and social gap in diabetes

A widening racial and social gap in diabetes m2ldr
On June 10, the 17th annual National Paediatric Diabetes Audit (NPDA) was published by the Royal College of Paediatrics and Child Health (London, UK). This latest iteration of the NPDA captured information on the care and outcomes of almost 30 000 children and young people (aged 0–24 years) with all forms of diabetes (95% with type 1 diabetes; 3% type 2 diabetes; 2% other forms) who attended a paediatric diabetes unit in England and Wales between April 1, 2019, and March 31, 2020. Concerningly, the audit found not just continuing but widening racial and social inequalities in type 1 diabetes care and outcomes. Specifically, the NPDA found that access to vital diabetes technology varied considerably by both race and ethnicity, and social deprivation status. Insulin pumps were used by only 27% of Black children and young people compared with 40% of White children and young people, and by only 32% in the most deprived areas compared with 44% in the least deprived areas—a gap that has almost doubled since 2014–15. Similarly, use of real-time continuous glucose monitoring was lower among Black children and young people (12%) than among White children and young people (20%), and in those from the most deprived areas (14%) compared with the least deprived areas (25%). A knock-on effect of reduced access to technology, Black children and young people and those from the most deprived areas had higher average HbA1c levels than their White, less deprived counterparts; a pattern also observed for those with type 2 diabetes. Worrying though the widening diabetes inequity revealed by the NPDA is, it is by no means surprising or even unique to children and young people with type 1 diabetes, or indeed to the UK. A 2019 Editorial in The Lancet Diabetes & Endocrinology highlighted how Black and minority ethnic adults in the USA and UK with type 1 and type 2 diabetes were less likely to be prescribed newer diabetes drugs and to have annual testing for HbA1c and retinopathy, and had higher risk of hospital readmission (suggestive of poorer initial care) than White people. Minority ethnic groups and low-income populations have long been known to shoulder a disproportionate burden of diabetes, having both higher disease risk and rates of diabetes complications and mortality. Data from the Centers for Disease Control and Prevention show that some racial and ethnic groups in the USA are twice as likely to be diagnosed with diabetes as White people (American Indian or Alaska Native [14·7%], Asian [9·2%], Hispanic [12·5%], Black, non-Hispanic [11·7%], White, non-Hispanic [7·5%]). The increased risk of diabetes and worse outcomes in Black and minority ethnic groups is further compounded and inextricably linked to higher levels of socioeconomic deprivation, in terms of income, education, occupation, housing, food security, social support, and access to quality health care. The COVID-19 pandemic has further widened diabetes inequalities, with people with diabetes being at increased risk of COVID-19 morbidity and mortality; consequently, Black and minority ethnic groups have been particularly hard hit. The acceleration of virtual health care during the pandemic might further contribute to widening diabetes inequity, favouring the least socially disadvantaged. In this issue of The Lancet Diabetes & Endocrinology, Sherita Hill Golden (Johns Hopkins University, Baltimore, MD, USA) charts how diabetes has evolved as a racialised disease in the USA over the past 130 years—transitioning from being perceived as a disease of White people to one of non-White people—and discusses how structural racism has led to current diabetes inequity. The ‘Black Lives Matter’ protests in 2020 following the death of George Floyd marked a sea change around the world, putting racism firmly at the top of the agenda for change. Now is the time to capitalise on this momentum to drive change at individual, organisational, and policy levels to eliminate the root causes of racial and social inequalities in diabetes and wider health—society can no longer ignore racism, whether individual or structural, conscious or unconscious, current or historic. Signs of change are already evident, with institutions and organisations implementing unconscious bias and anti-racism training, and diversifying their workforce; a start, but much, much more needs to be done. Equity in diabetes can be achieved for Black and minority ethnic groups, but not without recognising and counteracting the role of racism (current and historic) in creating and perpetuating diabetes inequalities. We can move forward—we must move forward—but first, we must look back.
On June 10, the 17th annual National
Possible spelling mistake. 'Paediatric' is British English.
Paediatric
Diabetes Audit (
Possible spelling mistake found.
NPDA
)
was published
by the Royal College of
Possible spelling mistake found.
Paediatrics
and Child Health (London, UK). This latest iteration of the
Possible spelling mistake found.
NPDA
captured information on the
You use this word too often, consider replacing it with
care
and outcomes of almost 30 000
You use this word too often, consider replacing it with
children
and
You use this word too often, consider replacing it with
young
You use this word too often, consider replacing it with
people
(aged 0–24 years) with all forms of diabetes (95% with
You use this word too often, consider replacing it with
type
1 diabetes; 3%
You use this word too often, consider replacing it with
type
2 diabetes; 2% other forms) who attended a
Possible spelling mistake. 'paediatric' is British English.
paediatric
diabetes unit in England and Wales between April 1, 2019, and March 31, 2020.
Possible spelling mistake found.
Concerningly
, the audit found not
This phrase/word is too simple and can be replaced with:
just
continuing
This phrase/word is too simple and can be replaced with:
but
widening racial and
You use this word too often, consider replacing it with
social
You use this word too often, consider replacing it with
inequalities
in
You use this word too often, consider replacing it with
type
1 diabetes
You use this word too often, consider replacing it with
care
and outcomes.

Specifically
, the
Possible spelling mistake found.
NPDA
found that access to vital diabetes technology varied
considerably
by both race and ethnicity, and
You use this word too often, consider replacing it with
social
deprivation status. Insulin pumps were
This phrase/word (depending on the context) can be potentially replaced with :
used
by
This phrase/word (depending on the context) can be potentially replaced with :
only
27% of Black
You use this word too often, consider replacing it with
children
and
You use this word too often, consider replacing it with
young
You use this word too often, consider replacing it with
people
compared with 40% of
You use this word too often, consider replacing it with
White
You use this word too often, consider replacing it with
children
and
You use this word too often, consider replacing it with
young
You use this word too often, consider replacing it with
people
, and by
This phrase/word (depending on the context) can be potentially replaced with :
only
32% in the most
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deprived
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areas
compared with 44% in the least
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deprived
areas—a gap that has almost doubled since 2014–15.
Similarly
,
This phrase/word (depending on the context) can be potentially replaced with :
use
of real-time continuous glucose monitoring was lower among Black
You use this word too often, consider replacing it with
children
and
You use this word too often, consider replacing it with
young
You use this word too often, consider replacing it with
people
(12%) than among
You use this word too often, consider replacing it with
White
You use this word too often, consider replacing it with
children
and
You use this word too often, consider replacing it with
young
You use this word too often, consider replacing it with
people
(20%), and in those from the most
You use this word too often, consider replacing it with
deprived
You use this word too often, consider replacing it with
areas
(14%) compared with the least
You use this word too often, consider replacing it with
deprived
You use this word too often, consider replacing it with
areas
(25%). A knock-on effect of
This phrase/word (depending on the context) can be potentially replaced with :
reduced
access to technology, Black
You use this word too often, consider replacing it with
children
and
You use this word too often, consider replacing it with
young
You use this word too often, consider replacing it with
people
and those from the most
You use this word too often, consider replacing it with
deprived
You use this word too often, consider replacing it with
areas
had higher average HbA1c levels than their
You use this word too often, consider replacing it with
White
, less
You use this word too often, consider replacing it with
deprived
counterparts; a pattern
also
observed for those with
You use this word too often, consider replacing it with
type
2 diabetes. Worrying though the widening diabetes inequity revealed by the
Possible spelling mistake found.
NPDA
is, it is by no means surprising or even unique to
You use this word too often, consider replacing it with
children
and
You use this word too often, consider replacing it with
young
You use this word too often, consider replacing it with
people
with
You use this word too often, consider replacing it with
type
1 diabetes, or
indeed
to the UK. A 2019 Editorial in The Lancet Diabetes & Endocrinology highlighted how Black and
You use this word too often, consider replacing it with
minority
You use this word too often, consider replacing it with
ethnic
adults in the USA and UK with
You use this word too often, consider replacing it with
type
1 and
You use this word too often, consider replacing it with
type
2 diabetes were less likely to
be prescribed
newer diabetes drugs and to have annual testing for HbA1c and retinopathy, and had higher
You use this word too often, consider replacing it with
risk
of hospital readmission (suggestive of poorer initial
You use this word too often, consider replacing it with
care)
than
You use this word too often, consider replacing it with
White
This phrase/word (depending on the context) can be potentially replaced with :
people
.

Minority
You use this word too often, consider replacing it with
ethnic
You use this word too often, consider replacing it with
groups
and low-income populations have long
been known
to shoulder a disproportionate burden of diabetes, having both higher
You use this word too often, consider replacing it with
disease
You use this word too often, consider replacing it with
risk
and rates of diabetes complications and mortality. Data from the Centers for
You use this word too often, consider replacing it with
Disease
Control and Prevention
This phrase/word (depending on the context) can be potentially replaced with :
show
that
This phrase/word is too simple and can be replaced with:
some
racial and
You use this word too often, consider replacing it with
ethnic
You use this word too often, consider replacing it with
groups
in the USA are twice as likely to
be diagnosed
with diabetes as
You use this word too often, consider replacing it with
White
You use this word too often, consider replacing it with
people
(American Indian or Alaska Native [14·7%], Asian [9·2%], Hispanic [12·5%], Black, non-Hispanic [11·7%],
You use this word too often, consider replacing it with
White
, non-Hispanic [7·5%]). The increased
You use this word too often, consider replacing it with
risk
of diabetes and worse outcomes in Black and
You use this word too often, consider replacing it with
minority
You use this word too often, consider replacing it with
ethnic
You use this word too often, consider replacing it with
groups
is
further
compounded and
inextricably
linked to higher levels of socioeconomic deprivation, in terms of income, education, occupation, housing, food security,
You use this word too often, consider replacing it with
social
support, and access to quality health
You use this word too often, consider replacing it with
care
. The COVID-19 pandemic has
further
widened diabetes
You use this word too often, consider replacing it with
inequalities
, with
You use this word too often, consider replacing it with
people
with diabetes being at increased
You use this word too often, consider replacing it with
risk
of COVID-19 morbidity and mortality;
consequently
, Black and
You use this word too often, consider replacing it with
minority
You use this word too often, consider replacing it with
ethnic
You use this word too often, consider replacing it with
groups
have been
particularly
This phrase/word (depending on the context) can be potentially replaced with :
hard
hit.
Three successive sentences begin with the same word. Consider rewording the sentence or use a thesaurus to find a synonym.
The
acceleration of virtual health
You use this word too often, consider replacing it with
care
during the pandemic might
further
contribute to widening diabetes inequity,
Possible spelling mistake. 'favouring' is British English.
favouring
the least
socially
disadvantaged.

In this issue of The Lancet Diabetes & Endocrinology,
Possible spelling mistake found.
Sherita
Hill Golden (Johns Hopkins University, Baltimore, MD, USA) charts how diabetes has evolved as a
Possible spelling mistake. 'racialised' is British English.
racialised
You use this word too often, consider replacing it with
disease
in the USA over the past 130 years—transitioning from
being perceived
as a
You use this word too often, consider replacing it with
disease
of
You use this word too often, consider replacing it with
White
You use this word too often, consider replacing it with
people
to one of non-White
This phrase/word (depending on the context) can be potentially replaced with :
people
—and discusses how structural
You use this word too often, consider replacing it with
racism
has led to
This phrase/word (depending on the context) can be potentially replaced with :
current
diabetes inequity. The ‘Black
This phrase/word (depending on the context) can be potentially replaced with :
Lives
Matter’ protests in 2020 following the death of George Floyd marked a sea
You use this word too often, consider replacing it with
change
around the world, putting
You use this word too often, consider replacing it with
racism
firmly
at the top of the agenda for
You use this word too often, consider replacing it with
change
.
This phrase/word (depending on the context) can be potentially replaced with :
Now
is the time to
Possible spelling mistake. 'capitalise' is British English.
capitalise
on this momentum to drive
You use this word too often, consider replacing it with
change
at individual,
Possible spelling mistake. 'organisational' is British English.
organisational
, and policy levels to eliminate the root causes of racial and
You use this word too often, consider replacing it with
social
You use this word too often, consider replacing it with
inequalities
in diabetes and wider health—society can no longer
This phrase/word (depending on the context) can be potentially replaced with :
ignore
You use this word too often, consider replacing it with
racism
, whether individual or structural, conscious or unconscious,
This phrase/word (depending on the context) can be potentially replaced with :
current
or historic. Signs of
You use this word too often, consider replacing it with
change
are already evident, with institutions and
Possible spelling mistake. 'organisations' is British English.
organisations
implementing unconscious bias and anti-racism training, and diversifying their workforce; a
This phrase/word (depending on the context) can be potentially replaced with :
start
,
This phrase/word is too simple and can be replaced with:
but
much, much more needs to
be done
. Equity in diabetes can
be achieved
for Black and
You use this word too often, consider replacing it with
minority
You use this word too often, consider replacing it with
ethnic
You use this word too often, consider replacing it with
groups
,
This phrase/word is too simple and can be replaced with:
but
not without
Possible spelling mistake. 'recognising' is British English.
recognising
and counteracting the role of
You use this word too often, consider replacing it with
racism
(
This phrase/word (depending on the context) can be potentially replaced with :
current
and historic) in creating and perpetuating diabetes
You use this word too often, consider replacing it with
inequalities
. We can
This phrase/word (depending on the context) can be potentially replaced with :
move
forward—we
This phrase/word (depending on the context) can be potentially replaced with :
must
This phrase/word (depending on the context) can be potentially replaced with :
move
forward—
This phrase/word is too simple and can be replaced with:
but
first
, we
This phrase/word (depending on the context) can be potentially replaced with :
must
look back.
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IELTS speaking A widening racial and social gap in diabetes

Speaking
  American English
4 paragraphs
729 words
5.5
Overall Band Score
Coherence and Cohesion: 5.5
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    Include an introduction and conclusion
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  • Use cohesive linking words accurately and appropriately
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    Vary your linking phrases using synonyms
Lexical Resource: 5.0
  • Try to vary your vocabulary using accurate synonyms
  • Use less common question specific words that accurately convey meaning
  • Check your work for spelling and word formation mistakes
Grammatical Range: 6.5
  • Use a variety of complex and simple sentences
  • Check your writing for errors
Task Achievement: 5.0
  • Answer all parts of the question
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    Present relevant ideas
  • Fully explain these ideas
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    Support ideas with relevant, specific examples
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